Saturday, November 8, 2014

Nuvigil + Coffee = Anxiety (for me)

I think I am going to have to give up coffee if I stay on Nuvigil- or at least switch to decaf. Coffee is one of my favorite things in the world, and it usually has more of an antidepressant effect for me than an anxiety-producing effect (unless I really overdo it). But it really seems apparent that my anxiety kicks up a notch, and I find myself reaching for the klonopin, after I have my coffee. And I drink it twice a day.

It wasn't as bad on the provigil- perhaps because I space out the doses. Nuvigil does feel a little bit stronger. Although on the higher dose of Zyprexa, I kind of need that in the mornings to get me going. I am hoping that higher dose isn't for too long- but I am still too vulnerable to go down I decided this week. When I was doing my meds this week, I was trying to figure out what dose of Zyprexa to put into my pill box.

I still haven't called about the appeal for my Provigil- I have been wondering if Nuvigil is better. But mostly I don't know when to call as I am at work during the day and don't think that there is anyone to talk to outside of work hours. At least anyone with the authority to do anything. I still don't know anything about the process or if I have any chance of getting approved.

I am looking to find a new therapist, one who takes my insurance. I don't really know how to find one, other than the psychology today website. I think it is probably in bad form to ask my current therapist for a recommendation. But I am totally not changing because of her, I am changing because of changes to my insurances. I suspect that she may have other clients who may leave too, as my hospital is a big employer.

I want a therapist who has some experience in DBT or ACT or some kind of mindfulness-based therapy. I want a therapist who has experience working with people with serious mental illness and won't freak out when I say how bad things are.

I got a notice in the mail about getting my mammogram. And I want to skip it. I can't imagine doing as something life-affirming as looking for cancer and maybe treating it so that I could live longer. But if I don't get it, my PCP will just hound me, and I really don't want to explain all of this- so maybe I will just go.


Unknown said...

OH and I think it is fine to ask for a therapist referral. She'll understand the reasoning. Dr. Mind has made it clear many times he'd refer me if I wanted to not drive so far or had someone who took Medicare (that and meeting my other requirements mean Hahahahahaha but it's nice of him to say that). And I think it is fine to be specific. Therapists usually seem to know other therapists in that area or know how to find out and they are able to help you find someone who clicks instead of going through new therapist hell 3 or 4 times before you get the right person. That is such a hard thing, to find the right person with no knowledge ahead of time.

Unknown said...

Ok, comment disappeared. Just saying that if you think there is any chance you have sleep apnea it might be worth a sleep study to find out if you do because if you do the Nuvigil is suddenly covered. I think that other sleep issues also get it approved and that anti-psychotics cause these as well as does the brain damage from having bipolar. My sleep was messed up in all kinds of ways when I was tested for apnea; I get almost no REM sleep and that helped get patient assistance Nuvigil when I was uninsured, although with mild apnea.

Jean Grey said...

I have thought about getting a sleep study- but you don't just need a diagnosis of sleep apnea, you also have to be "compliant" with a CPAP machine for 8 weeks before they would approve provigil or nuvigil. And I don't know how much a sleep study costs- I have a high deductible plan. And I might have to rent a machine just to say I am using it- which I can't imagine using.

Unknown said...

My sleep study cost about $1200 I think. It was the year that I was so sick from pertussis, had surgery, spent a week on psych and several days on medical with lithium toxicity (before a longer psych stay) so needless to say my deductible was long past.

That's weird that they require Cpap compliance. When I got it from patient assistance they didn't require anything. In fact they didn't even fight it at all; my doctor filled in the form, wrote that I had mild sleep apnea that didn't require CPAP and that I also had demonstrated severe sleep/wake cycle impairment and impaired sleep quality/lack of REM sleep complicated by severely sedating psychiatric medications that were making it difficult to work and about 2 weeks later the first shipment arrived. It was weird how easy it was to get it that way; we fought to get it when I was insured without any luck. Maybe patient assistance tends to rubber-stamp things? I don't know. I agree that having a CPAP sitting around for months would be going far.